COMPARISON OF EFFICACY OF METRONIDAZOLE VERSUS RIFAXIMIN IN TREATMENT OF HEPATIC ENCEPHALOPATHY

Abstract

Background: Hepatic encephalopathy (HE) is a severe neuropsychiatric disorder of liver cirrhosis, which is manifested by alterations in state of mind and neurological deficits caused by the accumulation of neurotoxins, including ammonia. Some of the treatment methods applied in the management of this condition include Rifaximin, which is a non-absorbable antibiotic, and metronidazole, which is a systemic antimicrobial agent.

Objective: To compare the effectiveness of rifaximin and metronidazole in treating the hepatic encephalopathy in pediatric patients.

Methods: This randomized controlled trial was done in the Department of Pediatrics of  Children's Hospital and Institute of Child Health, Faisalabad from June 2025 to September 2025. Two hundred four children aged 1-14 years with hepatic encephalopathy were recruited through non-probability consecutive sampling and were randomly given two equal groups. Group A was treated with rifaximin (220mg) twice a day through nasogastric tube and Group B was treated using intravenous metronidazole (1.5mg/kg) every 8 hours during five days. Day 5 in the West Haven criteria was selected to determine the efficacy of the treatment based on the improvement in the grade of the HE. Data analysis was done through SPSS 25. The efficacy of the two groups was compared through the chi-square test, and p not less than 0.05 was assumed to be statistically significant.

Results: Out of the 204 respondents, 118 (57.8%) individuals were male and 86 (42.2%) female. The age mean of the rifaximin group was 7.9 years and the age of the metronidazole group was 8.2 years (p = 0.62). The high-effect of the treatment was seen in 95 (93.1%) and 82 (80.4%) of the patients who had been given rifaximin and metronidazole respectively. The difference was found to be significant (χ² = 7.11, p = 0.008) which mean that the efficacy of rifaximin is superior. The efficacy of rifaximin was found to be higher in both age groups, and the statistically significant results were found in 8-14-year age (p = 0.04) group whereas gender and BMI did not seem to significantly raise or lower the treatment outcomes.

Conclusion: Rifaximin showed high efficacy when used in the treatment of pediatric hepatic encephalopathy, in comparison to metronidazole. Rifaximin can be used for treatment of hepatic encephalopathy in pediatric patients because of its excellent treatment response and good safety profile.